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2019-06-11T14:06:22.323Z

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To ask Her Majesty’s Government, further to the Written Answers by Lord Prior of Brampton
on 11 and 12 February (HL5764 and HL5766) and by Baroness Neville-Rolfe on 11 February
(HL5765), and in the light of current information about the increased extent of dangers
from the Zika virus affecting up to 20 per cent of all births, whether they intend
to issue further advice about, or to reconsider, in consultation with other European
governments, the long-term implications of participating in or attending the 2016
Olympic Games in Brazil.

<p>The British Olympic Association (BOA) and British Paralympic Association (BPA)
have prepared guidance to consider the health risks, including those posed by Zika,
for British athletes and staff travelling to Brazil for the Olympics.</p><p> </p><p>The
Department of Health has convened an Olympics health advisory group on behalf of the
Department for Culture, Media and Sport to focus on Zika and to support the BOA and
BPA to ensure that they can continue to provide the best possible information and
advice.</p><p> </p><p>The group will be chaired by the Department’s Chief Scientific
Advisor, Professor Chris Whitty, and will bring together experts from the BOA and
BPA as well as the London School of Hygiene and Tropical Medicine, University of Liverpool,
University of Nottingham, the Royal Free London, Public Health England and across
Government.</p><p> </p><p>Revisions of existing guidance or specific further advice
will be published if it is deemed necessary.</p><p> </p><p>In the meantime, Public
Health England and the National Travel Health Network and Centre (NaTHNaC) have developed
and issued more general travel advice online to health professionals that is suitable
for people travelling to Zika-affected countries, including pregnant women. A copy
of the online advice is attached.</p><p> </p><p>This includes a list of countries
where Zika virus transmission is occurring, advice around bite avoidance measures
and what and who to speak to if those travelling have concerns. PHE and NaTHNaC continue
to monitor the situation very closely and update advice as needed.</p>

To ask Her Majesty’s Government what assessment they have made of the case for more
resources to be made available for specialist support models for people with complex
support needs, and who do not benefit from the Work and Health Programme.

<p>The Government recognises the challenges of helping those with the most complex
health conditions move closer to work. The new Personal Support Package announced
in <em>Improving Lives: The Work, Health and Disability </em>Green Paper introduces
a range of new measures and interventions designed as part of a package of support
which can be tailored to people’s individual needs. The offer, which applies to all
Employment and Support Allowance claimants (and Universal Credit equivalents), includes
personal support from disability trained, accredited work coaches, with a focus on
mental health. Work coaches will be supported by an additional 300 Disability Employment
Advisers and around 200 new community partners with disability expertise and local
knowledge. This will lead to better signposting to other local voluntary and public
sector services that may be available. A copy of the Green Paper is attached.</p><p>
</p><p>The Government recognises that more needs to be done to help people stay well
at work, including those with complex health conditions. The consultation on the Green
Paper will help us to consider appropriate new models of support to help more people
with disabilities or long term conditions to enter and remain in work.</p>

To ask the Secretary of State for Health, what guidance his Department provides to
clinical commissioning groups about commissioning services on treatments from hospitals
(a) in Scotland and (b) outside their own area.

<p>Clinical commissioning groups’ (CCGs) commissioning responsibilities are set out
in the NHS Act 2006, The National Health Service Commissioning Board and Clinical
Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (SI 2012/2996)
and The National Health Service (Clinical Commissioning Groups— Disapplication of
Responsibility) Regulations 2013 (SI 2013/350), as amended.</p><p> </p><p> </p><p>
</p><p>NHS England have published the document ‘Who Pays? Determining responsibility
for payments to providers’ which provides guidance for CCGs on commissioning services
from hospitals in Scotland and outside their own area.</p><p> </p><p> </p><p> </p><p>A
copy is attached.</p><p> </p><p> </p>

<p>The rationale behind the benefit cap policy is set out in the Impact Assessment,
which supported the Welfare Reform and Work Act 2016. The final update was published
in August 2016 and is attached.</p><p> </p><p>DWP and HMRC administrative data was
used to inform the design of the benefit cap policy, and sample data was not used.</p>

To ask Her Majesty's Government how many families have had their tax credits reduced
by the two-child limit in each month since the introduction of the limit in April
2017; how many of those families had one or more parents in work; how many families
were (1) lone parent families or (2) two-parent families; and what was the number
of children per family involved.

<p>The government considers the impact of policies on different groups during their
development. During the passage of the Welfare Reform and Work Act 2016 we published
an Impact Assessment<sup><sup>[1]</sup></sup> for the policy of limiting support in
tax credits and Universal Credit. The impact assessment shows the number of Child
Tax Credit or Universal Credit claimants who were expected to be affected by the policy
over the next five years.</p><p> </p><p>This does not include a number of groups who
have received an exception to the policy of limiting support: statistics on these
exceptions will be published in due course.</p><p> </p><p>[1] <strong><a href="https://www.parliament.uk/documents/impact-assessments/IA15-006E.pdf"
target="_blank">https://www.parliament.uk/documents/impact-assessments/IA15-006E.pdf</a>
</strong></p><p> </p>

<p>Public Health England (PHE) has a responsibility to support the local delivery
of evidence-based, effective and sustainable weight management services, as recommended
by the National Institute for Health and Care Excellence (NICE), which support adults
who are obese (that is, with a body mass index over 30 kg/m2, or lower for those from
black and minority ethnic groups) or with other risk factors.</p><p>PHE provides practitioners,
commissioners and providers of tier 2 weight management services with a range of resources
to support the commissioning and delivery of these services. This includes:</p><p>-
Guidance on how services should include diet, physical activity, and behaviour change
components; and</p><p>- A tool to support the implementation of evidence-based behaviour
change techniques.</p><p>A copy of this tool, <em>Changing Behaviour: Techniques for
Tier 2 Adult Weight Management Services</em>, is attached.</p><p>NICE has also produced
a guideline, <em>Weight management: lifestyle services for overweight or obese adults,
</em>aimed at commissioners, health professionals, providers of lifestyle weight management
programmes, adults who are overweight or obese, their families and other members of
the public. This guideline covers lifestyle weight management services including programmes,
courses, clubs or groups provided by the public, private and voluntary sector. The
aim is to help people lose weight and become more physically active to reduce the
risk of diseases associated with obesity. A copy of NICE’s guideline is attached.</p>

<p>The Government has no plans to designate a group of healthcare professionals focused
on the prevention of rickets.</p><p>Rickets can generally be prevented by ensuring
that children have a healthy, balanced diet, spend some time outside in the sun and
take appropriate supplements containing ten micrograms of vitamin D. There is already
a range of resources available to increase awareness of the need for vitamin D supplements,
including advice on the NHS Choices website on the importance of vitamin D for bone
health, and supplements are readily available over the counter and through the Healthy
Start vitamins scheme.</p><p>In August the National Institute for Health and Care
Excellence (NICE) updated its public health guidance on increasing vitamin D supplement
use among population groups at risk of vitamin D deficiency, in the light of the 2016
Scientific Advisory Committee on Nutrition report on Vitamin D and health. A copy
of <em>Vitamin D: supplement use in specific population groups </em>is attached. This
guideline includes recommendations on how to: increase access to and availability
of vitamin D supplements, including for at-risk groups such as the BAME community,
ensure health professionals recommend vitamin D supplements, raise awareness of the
importance of these supplements amongst the population, and monitor provision and
uptake of vitamin D supplements. Local commissioners will wish to consider how best
to take forward these recommendations in respect of local BAME populations.</p><p>The
Government has made no formal assessment of the research referred to. Given the widespread
availability of vitamin D supplements and clear guidance to health professionals and
the public the Government does not believe there is a need for further strategies
to prevent rickets.</p><p> </p>

<p>The Government has no plans to designate a group of healthcare professionals focused
on the prevention of rickets.</p><p>Rickets can generally be prevented by ensuring
that children have a healthy, balanced diet, spend some time outside in the sun and
take appropriate supplements containing ten micrograms of vitamin D. There is already
a range of resources available to increase awareness of the need for vitamin D supplements,
including advice on the NHS Choices website on the importance of vitamin D for bone
health, and supplements are readily available over the counter and through the Healthy
Start vitamins scheme.</p><p>In August the National Institute for Health and Care
Excellence (NICE) updated its public health guidance on increasing vitamin D supplement
use among population groups at risk of vitamin D deficiency, in the light of the 2016
Scientific Advisory Committee on Nutrition report on Vitamin D and health. A copy
of <em>Vitamin D: supplement use in specific population groups </em>is attached. This
guideline includes recommendations on how to: increase access to and availability
of vitamin D supplements, including for at-risk groups such as the BAME community,
ensure health professionals recommend vitamin D supplements, raise awareness of the
importance of these supplements amongst the population, and monitor provision and
uptake of vitamin D supplements. Local commissioners will wish to consider how best
to take forward these recommendations in respect of local BAME populations.</p><p>The
Government has made no formal assessment of the research referred to. Given the widespread
availability of vitamin D supplements and clear guidance to health professionals and
the public the Government does not believe there is a need for further strategies
to prevent rickets.</p><p> </p>

To ask Her Majesty's Government what assessment they have made of research published
in Endocrine Connections finding (1) that the UK does not provide information to new
parents before discharge on the necessity of infant vitamin D supplementation, and
(2) that the vitamin D supplementation programme in infants is not monitored.

<p>The Government has no plans to designate a group of healthcare professionals focused
on the prevention of rickets.</p><p>Rickets can generally be prevented by ensuring
that children have a healthy, balanced diet, spend some time outside in the sun and
take appropriate supplements containing ten micrograms of vitamin D. There is already
a range of resources available to increase awareness of the need for vitamin D supplements,
including advice on the NHS Choices website on the importance of vitamin D for bone
health, and supplements are readily available over the counter and through the Healthy
Start vitamins scheme.</p><p>In August the National Institute for Health and Care
Excellence (NICE) updated its public health guidance on increasing vitamin D supplement
use among population groups at risk of vitamin D deficiency, in the light of the 2016
Scientific Advisory Committee on Nutrition report on Vitamin D and health. A copy
of <em>Vitamin D: supplement use in specific population groups </em>is attached. This
guideline includes recommendations on how to: increase access to and availability
of vitamin D supplements, including for at-risk groups such as the BAME community,
ensure health professionals recommend vitamin D supplements, raise awareness of the
importance of these supplements amongst the population, and monitor provision and
uptake of vitamin D supplements. Local commissioners will wish to consider how best
to take forward these recommendations in respect of local BAME populations.</p><p>The
Government has made no formal assessment of the research referred to. Given the widespread
availability of vitamin D supplements and clear guidance to health professionals and
the public the Government does not believe there is a need for further strategies
to prevent rickets.</p><p> </p>

To ask Her Majesty's Government whether they intend to develop strategies to implement
a rickets prevention policy alongside the existing infection prevention policy of
vaccinations, in the light of evidence published in Endocrine Connections demonstrating
that the UK has the worst adherence to infant vitamin D supplementation in Europe.

<p>The Government has no plans to designate a group of healthcare professionals focused
on the prevention of rickets.</p><p>Rickets can generally be prevented by ensuring
that children have a healthy, balanced diet, spend some time outside in the sun and
take appropriate supplements containing ten micrograms of vitamin D. There is already
a range of resources available to increase awareness of the need for vitamin D supplements,
including advice on the NHS Choices website on the importance of vitamin D for bone
health, and supplements are readily available over the counter and through the Healthy
Start vitamins scheme.</p><p>In August the National Institute for Health and Care
Excellence (NICE) updated its public health guidance on increasing vitamin D supplement
use among population groups at risk of vitamin D deficiency, in the light of the 2016
Scientific Advisory Committee on Nutrition report on Vitamin D and health. A copy
of <em>Vitamin D: supplement use in specific population groups </em>is attached. This
guideline includes recommendations on how to: increase access to and availability
of vitamin D supplements, including for at-risk groups such as the BAME community,
ensure health professionals recommend vitamin D supplements, raise awareness of the
importance of these supplements amongst the population, and monitor provision and
uptake of vitamin D supplements. Local commissioners will wish to consider how best
to take forward these recommendations in respect of local BAME populations.</p><p>The
Government has made no formal assessment of the research referred to. Given the widespread
availability of vitamin D supplements and clear guidance to health professionals and
the public the Government does not believe there is a need for further strategies
to prevent rickets.</p><p> </p>